Inguinal hernia is one of the most frequent entities treated by general surgeons. Open surgery has been the gold standard for many years, with mesh placement through an anterior approach by Lichtenstein or Rutkow-Robbins techniques.
With the emergence of laparoscopy, groin hernias, and other ventral hernias began to be treated by minimally invasive surgery. Laparoscopy in inguinal hernia promotes faster recovery with a near painless postoperative period. The transabdominal preperitoneal (TAPP) approach allows the surgeon to treat groin hernias through the usual and familial intra-abdominal space.
I have been using the laparoscopic TAPP approach for the past years, and it is impressive to see patients walking easily on the day after, free of symptoms and with huge smiles on their faces. Additionally, the mesh placement in a sublay fashion promotes a better outcome. These are some advantages of this minimally invasive technique compared to anterior open surgery. The TAPP repair has a shorter learning curve than laparoscopic TEP (totally extraperitoneal) repair.
However, some risks exist when using the TAPP repair:
risk of abdominal viscera injury (e.g., bowel, bladder)
risk of great vessels injury (iliac vessels)
risk of postoperative adhesions (peritoneum opening)
I must say that some years ago, I was not convinced this more expensive technique would be advantageous. But I changed my mind after seeing the postoperative recovery. Today, I believe the advantages of TAPP repair overwhelm the possible complications. Even so, surgeons must be aware of the potential complications, do everything to avoid them, and be ready to solve them.
Do you enjoy adrenal surgery? Must have this new book!
Costa Almeida CE, editor. Posterior Retroperitoneoscopic Adrenalectomy. Indications, Technical Steps and Outcomes. Switzerland: Springer; 2023.
I am sharing a new video of an inguinal hernia repair by the TAPP approach with the placement of a self-fixating mesh (Progrip® - Medtronic). This mesh (has one for the right side and another for the left side) does not need sutures or tackers for fixation, eliminating the risk of complications in the triangle of doom and the triangle of pain. Remember that no sutures or tackers should be placed on these areas (place no tackers or sutures below the iliopubic tract).
Enjoy the video.
Link to video:
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YouTube - click here
Dr. Carlos Eduardo Costa Almeida
General Surgeon
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